Final Stage Renal Failure/Pancreatitis-When is it the End?

ollieboy

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Hi there,

I joined this site because of an old post I read about Tiger from a couple of years ago and then found this updated post. I’m so happy to hear that he is still alive.  Good for you for going through so many ups and downs to save your baby. I really admire what you’ve done for your boy.

  I wanted to ask a few questions as my cat Oliver who had CRF, just had his first flare-up of his pancreatitis and he didn’t survive.  I’m completely devastated and am now wondering if I should have waited it out like you.  Oliver was a young cat of only 8 years 10 months.  He was diagnosed with CRF in March (3 months earlier) when he got bloodwork done which he hadn’t had done since he was a kitten. He always drank a ton of water since he was young so I wasn’t actually too surprised that he had CRF.  Canadian values. Creatinine=316 Urea (BUN)=22.8 SDMA=21 RBC was a little low at 6.9. So I changed his food and he seemed to tick along for a few months.  Then suddenly he got really lethargic and wasn’t eating much and had lost some weight. So I took him to the vet last week and he got full blood work done again. His Kidney numbers (Creatinine=718, Urea(BUN)=74.8 and SDMA=66) had sky rocketed and were all very abnormal Stage 4 or 5 Kidney failure. His phosphorus levels, Calcium, Potassium among other things were all off.  It was discovered that he had pancreatitis because his Spec fPLwas 50. His urine analysis was mostly normal with a trace of protein.  I had to transfer him to emergency so he could get 24 hour monitoring and he was given IV fluids for 5 days straight. They said by Monday that I should be able to take him home as he was showing improvement by moving around the cage and eating a little bit. They also said he was starting to get feisty. His Creatinine BUN etc. had come down a lot, but still not to the level of where he was in March. They said that would be his ‘new normal’ which was still quite high. Creatinine=460 BUN=36.5 They told me his pee was lacking concentration and he was peeing everything out and keeping little water. They told me to give him subcutaneous fluids daily and sent me home with antibiotics and painkillers. 

I knew when I got home that Oliver just wasn’t right but followed the new regiment of medications. He didn’t seem to be sleeping much and was sitting like a hen sits on her eggs and not lying down or sleeping as much as I expected him to sleep. And just sat in the dining room chair and seemed reluctant to come upstairs and sleep in my bed. He was barely eating and drinking  and only moved to use the litter box which was two rooms away. I had to keep the food right beside him on the dining room table along with his water.  I was so worried about him as he seemed kind of weak and lethargic. I called the vet at Emergency on Tuesday and she said to take him back for more blood work on Wednesday. The blood work came back on Thursday and the vet said Oliver is digressing. His pancreatitis  was still there with his Spec fPL at 50 and his kidney numbers were going back up Creatinine =562, SDMA=35 Urea(BUN)=45.2. His liver numbers were all abnormal now too. Oliver was fighting an infection as his RBC was down and WBC was up. He was showing signs of anemia as well. He also had a cold.

The 2 vets told me there was nothing left to do unless I wanted to get him a kidney transplant or dialysis which doesn’t have the greatest success rates and costs $1000s. So I decided to put him down. It was heartbreaking as I now wonder, what if they were wrong. What if Oliver just needed more times to get through his pancreatic flare-up as that is what originally seemed to be causing all this stress on his body. They said that he likely had other things going on e.g. cancer or a bad infection. I could have paid another $2000+ to get an ultrasound/x-ray, but they told me it likely wasn’t worth it as he didn’t appear to be getting better based on his blood work and the ultrasound would just confirm what we already know and that is, that he can’t be saved. It would offer us some answers if I was willing to pay the $2000+ for more analysis.  Oliver didn’t seem right to me, so I just let him go, rather than put him through more poking and prodding. The vet told me after I made my decision that I made the right decision for him and she would’ve done the same if it were her pet.


It was a very stressful time for me as my dog (greyhound) had to get major eye surgery (conjunctiva graft) because she got poked in the eye while playing outside. That cost me close to $4000 for the operation, weekly follow-up visits with the eye-doctor, eye-drops etc. She had to wear a cone for 8 weeks 24/7 and had to get a variety of eye-drops. It was all in the name of saving her eye and it was worth it. Just as she was getting better, Oliver took a turn for the worse and I was back to spending lots of time at the vet and emergency. So I was completely overwhelmed and not thinking clearly.

If spending more money could have saved him, I would have done it. However, I wasn’t sure if it was going to work and didn’t want him to suddenly start suffering terribly because I was waiting it out. 

Now that it’s over (he was euthanized last Thursday), I am having regrets.  I just miss him so much and now wonder if he could have pulled through this.

It sounds like Tiger pulled through after a lot of ups and downs and I wonder if Oliver could have done the same(?) Oliver was always a very bright-eyed energetic cat and I’d never seen him like this.

How long did Tiger’s pancreatic flare-ups last?  Were his kidney numbers stable or did they continue to go up and down by large amounts regularly?  For Oliver, he was a pretty healthy cat all his life, but drank a ton of water from day one. I’ve had him since he was 4 weeks old. His water drinking makes me think he always had kidney disease. I hadn’t had his blood tested regularly as he was a really hard cat to wrestle into a cage and take to the vet. It became sadly very east to take him to the vet once he got really sick though. I feel incredibly guilty.
Marissa
 

donutte

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For Oliver, he was a pretty healthy cat all his life, but drank a ton of water from day one. I’ve had him since he was 4 weeks old. His water drinking makes me think he always had kidney disease. I hadn’t had his blood tested regularly as he was a really hard cat to wrestle into a cage and take to the vet. It became sadly very east to take him to the vet once he got really sick though. I feel incredibly guilty.
Marissa
Hi Marissa, I can't speak from the pancreatitis standpoint because my CKD babies didn't have that. Well, they were never tested, but it ended up not mattering with them. But I did want to say, please don't regret what you did. You made the best decision you could with the information you had at the time. I know the "what-ifs" will eat us alive if we let them. I know it's human nature to analyze what we could have done better, or what did we miss, or what if we had the money for it.... all that does is make us feel worse though. So please do not feel guilty, and try not to focus so much on what could have been done differently.

It sucks because we have to make these decisions under duress, we don't have a way to turn off the emotional switch, nor do we often have the luxury of time to analyze things even if we did have an emotional shut-off switch. We just do the best we can do, there's nothing more we can do. At that moment, considering how she was at that time, with the information you had at the time, and the prognosis, you made what was the best decision you could.

:hugs: to you. I know you are in a horrible place right now, and you are in a stressful situation even more because of your doggie. I found out Sara had CKD less than a month after losing Lucky to acute renal failure, so I can relate. And I often wondered if when my mom said Lucky wouldn't take his pill that one time while I was in Portland was a big clue for me, and I should have taken him in then, a month before the inappetance hit. He likely had a tumor in his kidney, and financially, there was nothing I could have done, and I have to remind myself of that. He was also 16, and even if I could have afforded it, there was still a poor prognosis. So, I'm not sure if knowing then would have helped or not. I think the only thing it could have helped with was to help me mentally prepare for what was to come. And maybe nothing would have shown. I did the best I could. It took awhile to come to that conclusion, but eventually, I did.
 
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iloveprincess

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Hi OllieBoy,

What a heartbreaking time you are going through. It really pained me to read this as I can only imagine the grief, helplessness, and guilt you must be experiencing right now. First, I want to say please don't beat yourself up over the loss of Oliver. The guilt and what ifs can eat away at you and block you from acceptance and healing. Right now you are grieving and in shock, It's natural to want your baby back. I can't say if any of those expensive procedures would have made any difference, and it really sounds like you put up a good fight and did all that the vets recommended and more. I know how desperate it feels when your cat is going through a crash/flare up, and there have been many times that I thought it was the end. I would have made that call if Tigger hadn't rallied back the next day. Oliver must have told you it was his time, so trust that you simply listened to him. It does sound like your boy was definitely suffering and you gave him peace. It may be very well there was something more serious going on with him than just pancreatitis and CKD. Those numbers were extremely high for such a young cat and I don't think Tigger's levels were ever in that range (although I didn't always get lab work done when he was in crisis). 

I sent your message to a board member who is knowledgeable about CKD and if you'd like I can message you privately if you still want to discuss treatment, but also don't want to get too caught up in that. However, I can relate to that feeling of wanting answers and believing that more could have been done.

Big hugs and please hang in there 
 

ollieboy

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Hi there,

 

Thank you both so much for your kind words. They do make a lot of sense and do help me to feel a better.

 

Donnutte

I’m sorry to hear that Sarah was diagnosed with CRF so soon after you lost sweet Lucky.  It is so hard losing our pets as they are our family members who give us unconditional love, make us laugh and keep us company. It is truly a very special relationship that I feel so lucky to have with my pets.

 

I can relate to you with not finding out if there was a kidney tumour. Knowing that, likely wouldn’t have helped. The vet told me that they could do further tests to see if Oliver had cancer or something else going on, but like you said, knowing that wouldn’t have helped because his blood work had become so abnormal in several areas, which was a sure sign he wasn’t going to survive. That is why I think the vet didn’t encourage me to do more tests. She said that it was more stress for Oliver and he likely wasn’t going to survive that much longer anyway.

 

It’s true, it is really hard to make a decision when under duress. I was worried if I waited too long, Oliver may digress further very quickly and then would suffer a painful death without the benefit of euthanasia. On the other hand I was worried about letting him go sooner than he needed to in case there was a chance he could bounce back.  The vet did reassure me that I did everything I could possibly do and did not feel like Oliver was going to get better and I think I just have to believe that and not doubt the decision. It’s so hard to do as I am a very analytical person and like to look for patterns and trends.  This trait can sometimes drive me to worry and second-guess things.

 

I will a follow your advice and try not to analyze and dwell so much on Oliver’s final days and accept the decision I made.

 

iLovePrincess,

 

Thank you so much. Like your Tiger, I had a cat named Trixie who I thought was going to die on numerous occasions and seemed to rally back with treatments. She had diabetes for the last 9 years of her life and we went through a lot of ups and downs. I never knew a cat could be so resilient and good at bouncing back. Trixie lived until she was 22. By the end she had diabetes, hyperthyroidism and mild CRF.  Oliver is my first cat with CRF this severe and I’d hoped he’d bounce back sooner, but after a week of treatment he didn’t seem to get better and his blood work reflected that. It had been a week with some improvement while on the IV drip but once taken off, his numbers were all moving in the negative direction and more things were coming up, like abnormal liver numbers. I was getting extremely worried and panicky.

 

I read your Tiger story and could relate with all your ups and downs and it made me wonder if Oliver was just going through a hard time. Maybe the fact that Oliver wasn’t really bouncing back after a week was the sign.

 

I would love if you can forward the information on to the Board member in case he/she has anything to add. I would like to learn from this experience if possible. And be as informed as possible the next time I have to go through something like this.

 

Thank you so much. I really appreciate this a lot. You are very kind and supportive. Hugs to you both.
This is a great site.
 
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iloveprincess

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Hi Ollie,

I will reply to you privately.

 

kaoritokyo

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Hello.
I'm newbie in Japan,having my CRF end-stage cat,Su,on my lap.Here we rarely can find vets who do euthanasia.blame me for I cannot find.
Su,19yrs old my better feline half ,and each other is only family,quickly slipping away.He cannot move because of severe Anemia,I did all I could and at a lost.

I could borrow oxygen mask for pet,It's all I can do now.He outlived vet's expectations more than 1 week,with very frail body,and BUN 217 CREA 13.7 which didn't go down with 1week IV.also he build chest water.

I'm just holding him on my lap.He wants to be held.drinks water,but eat nothing.
I'm just waiting his suffering ends.

Sorry for murmur.I'm just helpless and sad.
(If anyone in yahoo group watching this post,Su slipped too fast and hard to report treatment-wise.I'll post his timeline for someone can read them)
 
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iloveprincess

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Wow I am so sorry to hear you guys are going through this! I'm not at my computer so I'll write more later but I found these 2 places who might be able to help:

Animal Rescue Kansai – Founded by a foreigner back in 1990, ARK is one of Japan’s foremost animal charities.

Japan Cat Network - Also founded by foreigners, JCN has been helping Japan’s cats since 1993.

I don't know their contact or where they're located or where you are though. Please reply ASAP with your location and I'll try to help you. In the meantime will your vet prescribe pain medication to keep your poor baby comfortable?
 

kaoritokyo

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Thank you iLovePrincess!

I'm living in Tokyo.(Eastern)

But vet says he will live few days,

And I have medication for seizures in case he have it.

Oxygen is working great,

And to be very honest(with my cultural background)

Euthanasia is hard for me,my head understand it,my mind is too scared.My head says It's right thing,still,my mind says maybe he want to stay home..or something...

As Su is my first cat and his condition worsened really fast,I can't make up my mind.(at the same time,I'm scared,thinking of he might suffer.)

I can't take Su to the vet cause now he is too frail,but I can talk with vet who knows Su.

I'm so sorry for weak-minded,It's midnight here and I'm too depressed.

I also learned homoeopathy and can use them to support my kitty.

Thank you and I'll stay strong.
 
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iloveprincess

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Sure, I respect your beliefs. Sounds like you are here for emotional support. This must be so devastating for you and terrible for Su. Would be good if your vet prescribed something for pain so he doesn't suffer but I don't know regulations there on that type of thing. 19 years is a very long time to be a cat mom so you've done a great job. I pray Su passes peacefully. You're not alone, I will be thinking about you and sending peace and comfort to you and Su
 
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iloveprincess

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Also, cats with anemia get very cold. Hopefully you are making a warm nest for Su or providing a heating pad.

I also just wanted to say that if fear is holding you back from euthanasia, it really isn't scary. Your kitty gets a shot and goes to sleep very peacefully. I can understand if you feel it is morally wrong though.

Please hang in there and update us on Su's condition and how you are doing
 

kaoritokyo

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Yes,I've been frantically seatched what to do,fortunately I found vet who is supportive,But emotionally I'm really broken.
I just fell asleep for 30 minites or so,and shocked to find Su is fallen between bed and wall.(small space,5cm width)
He just carm down with oxygen,but only 2weeks before,
He was sitting on bed,making box(how do you say cat's box-like style?)
And watching me.
Now he's like a rubber.
He's still peeing.I wonder I might make a mistake somewhere and if I did right decision,I could save him.

I'm sorry for this is really a vent!
Su has no heart problems at 19years old,It makes his fight longer.
I don't think I have moral block for euthanasia.
Rather,I'm not sure I can know when is right time,between me and Su.
When I said to vet "maybe he might die today"in front of Su,
Su stood up like "No I will not!".

So,I think he wants to live,more than I want him to live.
It's not a rational thinking..
 
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iloveprincess

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Wow, so sorry your Su is declining so rapidly. It's really hard to accept when it happens so suddenly. It's the most helpless and stressful feeling when you can't help your baby. 

While I'm not a vet, there are treatments your vet definitely could be trying for the anemia, such as medications called Aranesp or Epogen, B12 injections, or a blood transfusion, the fluid in his lungs  could be treated with Lasix and Furosemide, and the kidney failure with phosphate binders, potassium supplements if low, and syringe feeding him when necessary. The fluid in the lungs possibly from being over hydrated due to IV fluids can also temporarily raise his BUN and Creatinine. This is what we would try in the US, I'm not sure what's available there. It sounds like you are more focused on palliative care though? 
 

kaoritokyo

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We already tried Aranesp,he didn't use Lasix cause at first he began absorb chest water.
We went 2vets,first vet over hydrated him,and didn't treat high blood pressure,left Su blind.
On 2nd vet,over hyderation found out,so Su get IV very slowly.at first Su absobed water,but didn't last long.
He began build water even after Vet stopped IV.His responce to Epogen(once,on 1st vet)and Aranesp is too weak.

Blood transfusion could be game changer.But We didn't have cats who donates blood.
At the point,his number rose to BUN 217&CREA 13.
We did assisted feeding,with Phos Binder.
We drained Su's chest water 4 times.

After that,I decided to focus palliative care.
Now It's too dangerous to take him a vet cause he's too frail.
 
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iloveprincess

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Oh my, you and Su have certainly been through a lot. Sounds like you guys have given it your best shot. So sorry to hear Su is now blind too! How heartbreaking. That's unfortunate that you don't have access to donor blood for a transfusion. Very tough situation. I really feel for you and what you're going through. You clearly love Su and he's lucky to have you as his mom. 
 
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iloveprincess

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He's such a handsome tabby, like my Tigger 
 

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  My thoughts are with all cat guardians and kitty lovers who are dealing with this issue. I recently lost my devoted Cinder Cone aka "Cindy" to renal failure. My only regret is that at the end, she wasn't eating or drinking and I didnt know why till the vet explained to me that the kitties develop very painful mouth sores which prevents their eating/drinking, and that when those sores develop, they are really hurting and that is the time to "let go". If only I could have let Cindy go sooner, and spared her that misery.....

It will take courage and, most of all, LOVE to allow your beloved to have a peaceful passing - but please realize that even though losing them will cause you grief and pain, you are releasing them from theirs. Reassure them that you WILL be alright - now that you are here at TCS, you have a world (literally) of good, compassionate, UNDERSTANDING (because most of us have walked the same path) and love, to help you through what will be a terrible time, emotionally. If you are burying them, and want to do a traditional gesture, for some tribes anyway, include a lock of your hair next to their nose so that when it is your turn to cross The Bridge, your kitty will remember you (my personal belief is that they will know you anyway because the ancestors taught that those who have lived and died are on the Other Side with the descendants yet to be born). 

You can always Private Message any of the members here - my experiences have always been that when you reach out to a TCS member, you have found, as Dr. Phil puts it, "a soft place to land".  You are not alone...in fact, when you share your experiences, you are helping others worldwide who are also dealing with similar situations.  And when you are possibly ready (or sometimes when you are not, but are willing to do the right thing anyway) there is, or are, a kitty or kitties in desperate need of YOU - your home, your companionship, your care, etc.  Not necessarily to move in with you, but even if just for a visit in the shelter, as a foster guardian, or a small donation to a local cat rescue, or a donation to the veterinarian's, or to accompany a TNR cat trapper (some human company can be so uplifting while waiting for the trap to engage, and also it's more fun to share the experience - as they say, " a problem shared is a problem halved; a joy shared is a joy doubled).

A final thought:  True love isn't just being close and loving to your kitty when s/he is that cute, cuddly, bundle of kitten joy - it is also, possibly more so, being there when your kitty is old, and frail, and having trouble staying clean, having incontinence issues, needs to be hand fed, given meds & sub-q fluids, needs help to get up & down, extra cuddles and grooming,etc....THAT, dear hearts, is TRUE LOVE 
 Sincerely, Susan
 

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Wow, it's crazy how this is the first post I saw and read. I just took my 17yo kitty in to the vets today and she was diagnosed with "advanced renal failure." I have to make the decision today based off it she ate last night or not. Doc said he would teach me to give her fluids and I may be able to bring her home for a couple weeks of she did eat last night. Just worried if I do that, all it will do is prolong the suffering for her.
I'm 25yo and Ive had Zazoo all 17 years. Its heartbreaking. [emoji]128542[/emoji]

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I'm so sorry you and your baby are going through this.  My 18.5 year old cat Sandra is in end stage renal failure.  She was in the hospital last week.  She was getting subQ fluids for her kidneys, but recently started having heart disease issues.  Her chest was tapped to remove fluid.  Now she is on Enalapril and furosemide.  She also is anemic and had a blood transfusion while in the hospital and now she is receiving Aranesp.  I am constantly worried about her.  I get very little sleep at night.  I get up throughout the night to check on her and give her meals.  It's so terrifying and heartbreaking when they get sick and when they leave us, they take a part of our heart with them. 

I lost my other cat Thomas last summer to CHF.  His last days were so stressful.  I was in a constant state of worry and fear.  I didn't know what to do.   It hurt so much when he passed away, but I was also relieved that he was free from his illness.  I remember after he passed away I was so depressed.  I would constantly go look at the places he used to sleep.  He had a favorite blanket he used to always sleep on.  I cut the blanket in half and when he was buried, I wrapped him in one half and kept the other half for myself.  I miss him so much.  He was the sweetest and most affectionate cat.  But it gives me peace to know he is not suffering. 

I am sending prayers and hugs to you. 
 

kaoritokyo

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Thank you for all thoughts and prayers,
I'm sorry for inform,
My little fighter baby Su passed away 14:40 Today(Friday in Japan)
I'll cremate him tomorrow.

Hoping all CRF kitties have long and happy life.

Tonks,I gave Su Sub-Q fluid at home 4months,He was free from stress to go to vet and happy.as far as I know.

Tamu,as I have been depressed one,I can't say with big mouth,but please eat and sleep,even using meds,to protect Sandra.I'm glad Sandra could get blood transfusion.

I'm making little things for Su carry,And I'm not suicidal right now.Thanks to sleep.
I'll spend the last night with Su quietly.

Thank you. Kaori&Su(little birdie now)
 
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